Return to work after surgical treatment for carpal tunnel syndrome

Jacobs, J.E.D. (2017) Return to work after surgical treatment for carpal tunnel syndrome. thesis, Medicine.

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Abstract

Background Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome worldwide, especially presenting in elderly and working adults. It is caused by compression of the median nerve. The main goal of the treatment is to minimize clinical symptoms and maximize physical function, often performed by a surgical procedure. Due to the high prevalence of CTS, psychological and socio-economic consequences are becoming increasingly important. The absence from work is one of the socio-economic consequences being discussed. Until now, there is no consensus on the optimal timeframe of returning to work postoperatively. A wide range in days of sickness absence is reported and factors influencing the time to return to work are incompletely defined. The purpose of this study is to identify how many days after carpal tunnel surgery, a patient will have a safe return to work and which determinants are affecting the return to work. Methods The study consisted of a retrospective and prospective part. The retrospective study was conducted by using data pulled from a patient database where patients were patients had surgeries performed at the ‘Isala hand-wrist center’ between January 2013 and July 2016. We analysed 112 patients. Data was obtained from digital questionnaires sent to the patients preoperative, 6 weeks postoperative, 3 months postoperative and 6 months postoperative. In the prospective study, 51 patients were included during a 4-month period. Data collection took place preoperative and 6-weeks postoperative. The surgical intervention consisted of an open carpal tunnel release. The primary endpoint was the duration of sick leave after surgical treatment and secondary endpoint measurements were factors that may affect the duration of sick leave. Clinical improvement of symptoms and functional status were measured with the Boston Carpal Tunnel Questionnaire (BCTQ). Results Retrospective study; the median duration of sick leave from work after carpal tunnel surgery was 3 weeks. Work type was the only significantly correlated factor affecting return to work postoperatively (p=0.017). The time to return to work was statistically significant longer in heavy workers compared to light workers (mean duration of sick leave 3.9 weeks versus 2.9 weeks, p=0.045). After 6 weeks, 30% of the patients did not return to work; work type was associated with the return to work after 6 weeks. After 6 months, no differences were found in the overall time result of the surgical treatment of CTS. In the prospective study, the median duration of sick leave was 20 days. At 6 weeks, 90% of the patients returned to work, of which 41% of the patients returned to work during the first 14 days. Factors significantly correlated with the return to work were education level (p=0.044), work type (p=0.025), number of days patients expected to be out of work (p<0.001) and number of days patients wanted to stay out of work (p=0.001). Work type was the most important clinical factor, which showed that heavy workers (22.6 days, p=0.02) and moderate workers (23.3 days, p=0.032) returned to work significantly later compared to light workers (10.7 days). In both retrospective and prospective studies, the BCTQ score was significantly reduced over time. Conclusion The median duration of sick leave from work after carpal tunnel surgery is 20 days, with work type as the main determinant affecting return to work. Other factors affecting return to work are number of days patients expected and wanted to be out of work. The decline of the BCTQ score over time indicates clinical improvement in our study population.

Item Type:	Thesis (Thesis)
Supervisor name:	Faculty supervisor and Dr. P. Houpt and Department of Plastic Surgery, Isala and Methodology and statistical supervisor: and Brohet, Dr. and Department of Innovation & Science and Isala Hospital Zwolle
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:49
Last Modified:	25 Jun 2020 10:49
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1046

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